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Epidemiology

Pelvic fractures can be seen in any group of patients. Like much trauma, there is a bimodal distribution with younger male patients involved in high-energy trauma and older female patients presenting after minor trauma.

Clinical presentation

Patients tend to present following trauma with pelvic/hip pain. They will often be immobilised by ambulance crews on arrival and potentially have other life-threatening conditions associated with high-energy trauma.

The type of fracture that occurs is a result of the type of injury (impact or compression), the energy involved and the strength of the bones.

The potential morbidity associated with these fractures is related to the involvement of the pelvic ring. Injuries that result in disruption of the pelvic rings result in a significantly worse prognosis.

Direct impact low-to-moderate energy injuries usually result in a solitary and localised fracture. Compression injuries tend to cause fractures that involve the pelvic ring and are unstable.

Classification

Four main forces have been described in high-energy blunt force trauma that results in unstable pelvic fractures 1, 3, 5:

anteroposterior compression: result in an open book or sprung pelvis fractures

Associated injuries

Pelvic fractures carry a significant risk of uncontrolled pelvic bleeding and exsanguination from pelvic fractures is a real possibility. This may result in pelvic, thigh and/or retroperitoneal haemorrhage. Pelvic angio-embolisation should be considered in patients with evidence of persistent blood loss with no evidence of intra-abdominal bleeding prior to surgical fixation 3, 4.

Radiographic features

The radiographic features are varied and even for serious and severe injuries can be subtle on plain radiographs.

Plain radiograph

X-ray is a quick and simple test that will detect the majority of pelvic fractures. They can be difficult to assess because of the complexity of the shape of the sacrum, pelvis and proximal femora.

CT

CT is the modality of choice for accurately depicting complex acetabular or pelvic ring fractures. After an initial plain radiograph, a CT is often required to make an accurate assessment of the fracture.

Treatment and prognosis

Treatment and prognosis depend on the type of injury. Simple ramal fractures are treated by immobilisation. Multi-part acetabular fractures require reconstruction by an experienced operator. Complex pelvic ring fractures may require external fixation. In these patients, their prognosis is partly dependent on their comorbidities and other related injuries.

Pelvic fractures carry a significant mortality and morbidity. It has been reported that ~75% of pre-hospital deaths from motor vehicle collisions are secondary to pelvic fractures 3.